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Witness Testimony of Donald A. Simoneau, and Member, National Legislative Council, Past Commander, Department of Maine, American Legion

Mr. Chairman and Members of the Subcommittee:

Thank you for this opportunity to present The American Legion’s views on women, special needs, and rural veterans. As more eventual veterans return from Iraq and Afghanistan, a higher emphasis is being placed on the Department of Veterans Affairs (VA) to provide the highest quality of care to all veterans who have served our nation and earned the entitlement. 

Within the veteran population, the provision of quality health care to women veterans, special needs veterans, and rural veterans has proven to be very challenging, given factors such as limited availability of skilled care providers and inadequate access to care. Other challenges such as miscommunications and misperceptions of Veteran Health Administration (VHA) services also continue to impede the delivery of quality care to the veteran population.  The American Legion commends the Subcommittee for holding a hearing to discuss these vitally important issues.

Women Veterans

According to VA research, women make up approximately 15 percent of the active force, are serving in all branches of the military, and are eligible for assignment in most military occupational specialties except for direct combat roles. The increase in the number of women serving in the military significantly impact the services provided by the Department of Veterans Affairs (VA). VA also projects that by the year 2010, women will comprise well over 10 percent of the veteran population, an increase of 6 percent over current figures.  The state of Maine is comprised of approximately 9,396 of these women veterans.

Although integrated within the ranks, these women veterans require special treatment to ensure they have the best chance of returning to good health. Research has shown that female veterans encounter three large barriers when trying to access health care through VA. These barriers include: lack of knowledge about VHA services; unaware of eligibility for health care benefits; and the perception that VA only caters to male veterans.  During various site visits to VA Medical Hospitals, Vet Centers, and Community Based Outpatient Clinics (CBOCs), the American Legion met with various managers who stated their greatest challenge was accommodating women who suffered from Military Sexual Trauma (MST).  It is imperative that VA has adequate funding and resources, to include staffing, to ensure tools such as private entrances are in place, thereby encouraging more women to come forward and obtain care.

The American Legion recommends that once women veterans’ needs are identified, VA develop and implement policy to address these deficiencies in a timely manner and conduct an extensive outreach campaign to ensure this special population—and those who serve them—aware of enhancements in health care services.  We also urge Congress to also appropriate adequate funding to maintain these enhancements, once in place.

Special Needs Veterans

The American Legion is concerned with the needs of all veterans; to add, we must reassure to all that special needs veterans (SNV) don’t slip through the cracks of the VA health care system. Recently in my hometown here in Maine we lost one of these Special Needs Soldiers, who served two tours of duty in Iraq but slipped through the cracks, in the VA system. This should not have happened, to anyone, especially someone who gave so much to us, but it is happening all across the nation. Special Needs Veterans, according to the Diagnostic Statistical Manual (DSM) IV, include the chronically mentally ill, which are conditions of schizophrenia or major affective disorder including bipolar disorder, or Post Traumatic Stress Disorder (PTSD). Many older veterans are dealing with PTSD and have for years and never diagnosed. Many returning veterans are dealing with TBI or Traumatic Brain Injury, which is one of the newest Special Needs Veterans issues. Special Needs Veterans also includes the frail elderly or those veterans who are 65 years of age or older with one or more chronic health problems; and limitations in performing one or more activities of daily living. The last major group with special needs is the homeless.

The issue of homelessness affects every category of veteran.  The VA Advisory Committee on Homeless Veterans 2007 report states the need and complexity of issues involving women veterans who become homeless are increasingly unexpected.

The increased risks of homelessness among each of these populations, warrant funding for special needs grants.  The American Legion strongly urges Congress to provide VA with the adequate funding, ensuring more grants be put into place to assist those veterans with special needs.

Special Needs Veterans also encounter barriers when trying to access health care through VA.  These obstacles include: lack of knowledge about VHA services, not knowing that they may be eligible for health care benefits, and a negative perception of VA.

The American Legion maintains that VA has a duty to constantly seek new ways to bring information to veterans—ALL veterans. 

Rural Veterans

The American Legion believes veterans, many of whom are elderly and infirm or unable to travel, are isolated from the regular, preventative medical attention they need and deserve.  Providing quality health care in a rural setting has proven to be challenging with such dilemmas as limited availability of skilled care providers and inadequate access to care.

VA’s ability to provide treatment and rehabilitation to rural veterans who suffer from the “signature ailments” of the on-going wars in Iraq and Afghanistan (Traumatic blast injuries and combat-related mental health conditions) will continue to be challenged if it lacks the appropriate resources to accommodate new returning and existing veterans.  According to Title 38, United States Code, Section 1703, VA has the authority to contract for services where they are needed. 

Mr. Chairman, with that measure in place, we have to persistently ensure funding and resources are available to facilitate the needs of veterans who reside in rural locations.  We also encourage VA to periodically assess the resources in place and match against those who have returned.  This assessment will determine the future needs of our nation’s veterans, to include those who reside outside normal distances of the VA Medical Center system.

The American Legion believes that where there is limited access to VA healthcare, it is in the best interest of veterans residing in highly rural areas to have local care made available to them. This would alleviate the unwarranted hardships rural veterans encounter when seeking access to VA health care services.  Veterans should not be penalized or forced to travel long distances to access quality health care because of where they choose to live. 

On October 15, 2004, the VA Office of Inspector General (VAOIG) released the “Evaluation of Department of Veterans Affairs Policies and Procedures Addressing the Location of New Offices and Other Facilities in Rural Areas.” This report examined VA’s policies and procedures to give first priority to locating new offices and other facilities in rural areas, as outlined in the Rural Development Act (RDA) of 1972.

The report determined that despite not having formal policies in place, VA did make a significant effort to improve access to VA services for veterans living in rural areas.  The American Legion commends VA’s efforts, however, we urge the Congress to ensure there are an adequate number of resources for veterans, as well as provision of adequate funding and care whilst VA is making efforts to accommodate the veteran.

The American Legion believes that CBOCs serve as a vital element of VA’s health care delivery system when rural veterans are being discussed.  As is widely known, there is great difficulty serving veterans in rural areas. According to the 2000 Census, many rural and non-metropolitan counties across the nation had the highest concentrations of veterans in the civilian population aged 18 and over from 1990-2000.  The State of Maine has the fourth highest proportion of veterans living in rural areas in the nation at 15.9 percent.  Studies have further shown that veterans who live in rural areas are in poorer health than their urban counterparts. In states such as Nevada, Nebraska, Iowa, North Dakota, South Dakota, Wyoming, Montana, and Maine, veterans face extremely long drives, a shortage of health care providers and bad weather.  In Maine we are waiting for the funding for Lewiston, Dover/Foxcroft, Farmington and Norway/So. Paris  CBOCs and grateful for the Lincoln CBOC that opened recently. The Veteran Integrated Services Networks (VISNs) rely heavily upon these CBOCs to close the gaps. The American Legion urges the Congress to adequately fund VHA to ensure an adequate number of CBOCs are constructed and maintained.

Although effective, CBOCs are not the only avenue with which VA can provide access to quality health care to rural veterans. VA must enhance existing partnerships with communities and other federal agencies to help alleviate barriers that exist, such as, the high cost of contracted care in rural settings.  The American Legion believes coordinating services with Medicare or other healthcare systems based in rural areas is another way to provide quality care.

In closing, providing quality health care to women veterans, special needs veterans, and rural veterans has proven to be very challenging, given factors such as limited availability of skilled care providers and inadequate access to care. Other challenges such as miscommunications and misperceptions of Veteran Health Administration (VHA) services also continue to impede the delivery of quality care to theses veteran populations. 

The American Legion believes all veterans who are entitled to VHA services should receive it in a timely and quality manner. Lastly The American Legion urges the Congress to provide adequate funding to VA to accommodate the modernization of all VA structures.  The modernization of VA structures would readily provide telehealth and telemedine to all veterans who reside in rural areas. 

Again, thank you Mr. Chairman for giving The American Legion this opportunity to present its views on such important issues. We look forward to working with the Subcommittee to bring an end to the disparities that exist in access to quality health care to women veterans, special needs veterans, and rural veterans. 

For God & Country.